Strengthening existing surveillance platforms to monitor pandemic-prone pathogens
Authors: Augustina Angelina Sylverken
Journal: The Lancet Global Health (2023)

The COVID-19 pandemic is arguably the most devastating pandemic that has occurred during the past century. In most countries, the priority was case finding, contact tracing, and other management efforts to control and limit the spread of SARS-CoV-2. WHO and other health regulating bodies recommended the implementation of strategies that included leveraging existing platforms to respond to the pandemic. The Global Influenza Surveillance and Response System, a network of laboratories that provides surveillance for influenza, has recommended integrating COVID-19 surveillance into its existing influenza surveillance networks to achieve a more comprehensive approach to monitoring respiratory viral pathogens with pandemic potential. Rapidly modifying existing surveillance platforms to detect new cases of COVID-19 was imperative and yielded positive results.1Hammond A Cozza V Hirve S Medina M-J Pereyaslov D Zhang W Leveraging global influenza surveillance and response system for the COVID-19 pandemic response and beyond.China CDC Wkly. 2021; 3: 937-940Crossref PubMed Scopus (7) Google Scholar However, there are important lessons and questions that need to be addressed. In this issue of The Lancet Global Health, Asante and colleages2Asante IA Hsu SN Boatemaa L et al.Repurposing an integrated national influenza platform for genomic surveillance of SARS-CoV-2 in Ghana: a molecular epidemiological analysis.Lancet Glob Health. 2023; 11: e1075-e1085Summary Full Text Full Text PDF Google Scholar provide clear evidence that SARS-CoV-2 surveillance can be effectively integrated into an existing influenza surveillance network. The authors were able to detect the continuous circulation of influenza in Ghana by using the national influenza surveillance platform and including SARS-CoV-2 surveillance. They report that influenza was a major cause of both influenza-like illness and severe acute respiratory illness. The success in detecting multiple respiratory viruses was possible because of the use of an existing platform, showing the value of leveraging established systems for new surveillance efforts. Currently, other countries are gradually using existing surveillance platforms to identify other pathogens, especially in the context of COVID-19.3Kinkade C Russpatrick S Potter R et al.Extending and strengthening routine DHIS2 surveillance systems for COVID-19 responses in Sierra Leone, Sri Lanka, and Uganda.Emerg Infect Dis. 2022; 28: S42-S48Google Scholar, 4Hammond A Cozza V Hirve S Medina M-J Pereyaslov D Zhang W Leveraging global influenza surveillance and response system for the COVID-19 pandemic response and beyond.China CDC Wkly. 2021; 3: 937-940Crossref PubMed Scopus (7) Google Scholar Much progress has been made in building capacities nationally, regionally, and globally to protect the world from influenza.5Sambala EZ Ndwandwe DE Imaan LM Wiysonge CS Evaluation of influenza surveillance systems in sub-Saharan Africa: a systematic review protocol.BMJ Open. 2019; 9e023335Crossref Scopus (3) Google Scholar This progress can be used as a basis and an example for monitoring other epidemic-prone and pandemic-prone pathogens, especially those of respiratory origin. However, developing context-specific solutions to achieve any integration of existing surveillance platforms based on pandemic or epidemic response objectives is important. Although in most parts of the world, influenza activity was lower during the COVID-19 pandemic than before the pandemic, an epidemic can emerge at any time. Conversely, animal influenza viruses continue to sporadically infect humans.6Peiris JS Poon LL Guan Y Emergence of a novel swine-origin influenza A virus (S-OIV) H1N1 virus in humans.J Clin Virol. 2009; 45: 169-173Crossref PubMed Scopus (297) Google Scholar, 7Everest H Hill SC Daines R et al.The evolution, spread and global threat of H6Nx avian influenza viruses.Viruses. 2020; 12: 673Crossref Scopus (12) Google Scholar This sporadic infection highlights the continuing threat of zoonotic transmission and the need to remain vigilant for any eventualities while working with the One Health concept in mind. The One Health concept can guide existing platforms, such as the health, environment, and veterinary sectors, in detecting new pathogens. This process can happen if these three sectors work collaboratively, as WHO and other health agencies recommend, as there would be effective surveillance for new pathogens in these three sectors. This can further lead to an enhanced preparedness for pathogens of respiratory origin with epidemic and pandemic potential. There is the need to remain alert to the possibility of another respiratory virus emerging and causing the next pandemic. Because of the uncertainty of when the next pandemic might emerge, health regulating bodies at national, regional, and global levels should repurpose and strengthen existing surveillance platforms to detect respiratory viral pathogens with epidemic or pandemic potential quickly. To achieve more integrated surveillance systems for influenza, an integration of a range of other respiratory viruses with epidemic or pandemic potential into existing influenza surveillance infrastructure is required. This integration might involve exhaustive data collection and management and the development, evaluation, and validation of multiplex or combination assays to test samples for influenza and other epidemic-prone or pandemic-prone respiratory viruses simultaneously. Therefore, the responsibility of all national, regional, and global partners is to strengthen existing surveillance platforms to monitor any pandemic-prone pathogens to avert any severe eventualities. I declare no competing interests. Repurposing an integrated national influenza platform for genomic surveillance of SARS-CoV-2 in Ghana: a molecular epidemiological analysisThis study shows the value of repurposing existing influenza surveillance platforms to monitor SARS-CoV-2. Influenza continued to circulate in Ghana in 2020 and 2021, and remained a major cause of severe acute respiratory illness. We detected importations of SARS-CoV-2 variants into Ghana, including those that did or did not lead to onward community transmission. Investment in strengthening national influenza surveillance platforms in low-income and middle-income countries has potential for ongoing monitoring of SARS-CoV-2 and future pandemics. Full-Text PDF Open Access